IS IT JUST LUCK?

      In medicine we act based on what we think or know as facts. But many a times the facts are based on statistics. When we treat someone with  bronchitis- cough with yellow sputum, fever and wheezes= we treat with certain antibiotics and expect it will help and cure the respiratory infection. I believe that treating with antibiotics to cure him his based on FACTS .But in reality it is based on statistics and experience that antibiotics work in certain infection. But it may or may  not. But I often used to say that if one puts one hand in boiling water and other in ice cold water , 'statistically ' he is at comfort. That brings me to the story for today. 

    I saw this 70 years old male who was a smoker for cough and congestion. He had been smoker for 50 plus years and had no desire to quit. He had cough and wheezes and we did work up. he had breathing test and chest x- ray and was started on some bronchodilator. He continued to see me for 2 years and was doing OK .He had COPD and that was mild and he was active and cough improved . Then when I did new chest x- ray , he had abnormality . When I called him and wanted to do CT scan, he wanted to hold off and wanted antibiotics. So I did that and the repeat chest X- ray continued to show the abnormality . We did work up and he had cancer diagnosed . He underwent surgery and cancer was taken out. But he had some lymph nodes positive for cancer spread and so i sent him to oncologist and radiation doctor. He was told that the chance of recurrence in increased when the nodes show spread and he should have chemotherapy and or radiation . He did not want any further treatment. 

     I continued to do follow up and in next year or two, he had ne scan showing new mass . Again we did the work up and he had new cancer. I sent him to thoracic surgery and he did not feel surgery was an option as he had cancer spread to lymph nodes and so we decided to do radiation and suggested chemo and he was not sure . I continued to do follow up and he was doing OK . He had continued to smoke and the breathing test did not show much worsening. He did get radiation and no chemo.

   I continued to do the follow up and did periodic CT scan . 2 years or so after the second cancer. He was doing great and he had continued to smoke and was having no new complaints. He had new CT scan and he had some chest wall pain. The CT scan showed that he had new tumors and the ribs on rt side were also involved  and showed cancer. I sent him to radiation oncologist and medical oncologist . He was started on radiation and immunotherapy. He had some additional medications for pain . Almost 2 years have passed and he has continued to smoke  and has had new scans and breathing test . The breathing test does not show any significant worsening from previous one . He does not need oxygen .He has not been on any cancer medications for more than a year .AND HE IS AGAIN CANCER FREE . 

NOT SURE WHAT SHOULD HAVE HAPPENED TO HIM STATISTICALLY !!